When Tony Blair at the Labour Party conference invoked 'the patient courage of the changemaker' to describe the mission of his third term, he was making three colossal assumptions:

1) change is good;

2) change will be unthinkingly resisted;

3) given sufficient patience and courage, one-off change can be achieved by managerial effort, after which the organisation will have been successfully turned round and will be facing in the direction the changemaker intended.

When the Prime Minister added that in every case in retrospect he wished he had pushed his reforms further, he was effectively turbo-charging these assumptions.

Yet each one of them is as trustworthy as an Alastair Campbell denial. That change is inevitable, non-stop and pervasive as never before is the biggest management cliche of all. As Chris Grey, professor of organisational theory at the Judge Institute, puts it in his indispensable and subversive Studying organisations, change has become a fetish.

Yet this self-serving narrative is undercut time and again by both statistics and common sense. Job tenures have not shortened, and full-time employment is still the norm. On many measures the world economy is no more globalised now than at the end of the nineteenth century. Despite the internet, the laws of economic gravity still operate. And it is hubristic narcissism to think that change today is more wrenching than it was, say, during the Industrial Revolution in the late eighteenth century.

In fact, the most salient fact about today's change is how much of it, rationalised by the fetish, is both self-created and self-defeating. The fatal starting point is the idea that change can - and must - be imposed by the 'changemaker' top down. Thousands of examples show that this is a fantasy, and both theoretical and practical considerations suggest why.

Remote atop the already distant management factory, the change leader has no way of knowing how his/her decisions, however 'courageous' and 'patient', will play out on the ground. So unintended consequences abound - targets being a prime example. But even if managers could foresee the myriad theoretical consequences of a course of action, they would still run up against human agency.

On the one hand, organisations can't afford to switch human initiative off: a leader can't do everything alone. But on the other, agency has unpredictable results - people disagree. In the presence of agency, the idea that organisations can be redirected like machines is futile.

Either way, top-down change is an unwinnable battle against unintended consequences, which eventually mandate further change to mitigate the damage. In this sense, as Grey puts it, 'change management' is 'a perennially failing venture', doomed to reproduce itself in a never-ending loop: change as stasis.

There's no better example of this self-perpetuating treadmill than the original English patient, the NHS. As Polly Toynbee noted recently in the Guardian, since 1948 the NHS has been 'reformed' on average once every six years. New Labour has easily surpassed that. The current overhaul is not only the third in eight years; it neatly returns the service to where it was when it came in, although under different terminology.

In this orgy of motionless change, the work is not managing hospital beds or patients, let alone health, but change itself: the mad bureaucracy of targets, relationships that have to be reforged, jobs redescribed and reapplied for - and now new IT and office systems embedded to implement payment by results.

In only one respect can this round of 'reform' be said to be succeeding - that of deliberately destabilising the service. The avowed aim is to make it easier to import change. But that is a dangerous game, the likely consequences magnified by the fact that in dealing with the NHS the government doesn't seem to be able to distinguish between an organisation and a market.

This matters. An organisation is not a market. It has different functions and logic, and treating one as the other is a howler, as sure a means of creating confusion and make-work as the other self-generated reforms. The changes are designed to make health (and education, and as much of the public sector as possible) into a market. To work, a market needs clear rules and strong competition so that good solutions come to the fore and weaker organisations have an incentive to improve.

But where does strong competition come from? From - duh - vibrant organisations, with the autonomy, confidence and capacity for real change: to devise new and better ways of meeting the needs of customers (this is called R&D). The market disposes, but it needs organisations to propose in the first place. The two are symbiotic. The situation in the public sector, with complicated pseudo-markets and organisations crippled by central targets and constant interference, is the worst of all worlds, rule-bound, bureaucratic and unpredictable.

In the final analysis, as Chris Grey suggests, the narrative of change is most often not one of rationality but of ideology: a power play, a cover for the attempt to impose one version of 'efficiency' (the market) over another, and to discredit those who disagree as self-evidently retrograde, if not evil. Not so much the patient courage of the changemaker, then: more the self-righteous delusions of the fundamentalist.